Dear editor:
As our duly elected president and legislators take on the voter mandate of reforming the runaway federal government it was inevitable that every meaningful change would receive criticism.
No one needs a PhD in economics to understand we have 36 trillion reasons to make changes in federal spending. Recently Representative Hageman was accused of being disingenuous (or worse) when it came to the issue of Medicaid reform, a baseless accusation founded in frustration and an inability to face fiscal reality by some.
Medicaid is a safety net healthcare coverage program formed in 1965. It has helped care for children, mothers and the elderly for decades. Most of us who provide healthcare accept and care for Medicaid patients even though for the last 30 years its reimbursement rates do not come close to covering the cost of the care. Hospitals are forced to accept many Medicaid patients under EMTALA, a law that says they may not turn away anyone.
But what devout "never reform" Medicaid proponents will not admit is that it disincentivizes work. It also encourages single parent homes, widely accepted as the one greatest negative contributing factor of childhood poverty. Currently there are over 70 million people on Medicaid, about a quarter of the population in most states.
Intended as a small safety net poverty program, Medicaid exploded under the Affordable Care Act with other federal incentives growing to be the largest payer in the country, larger even than Medicare. In Wyoming, where our unemployment rate hovers around 4%, our Medicaid-funded birth rate runs about 40%.
Obamacare threw fuel on these flames with Medicaid Expansion, allowing able-bodied adults to enter the Medicaid program. (In Gillette in 2014 Medicaid patients tripled in less than a year without expansion.) Obamacare offered to pay for 90% of the cost of these newly Expanded Medicaid recipients to states willing to "expand". Traditional cost-sharing with states had been a 50% fraction.
While I am not privy to policy discussions at the federal level, those people trying to save our government from fiscal collapse are probably looking to lower this 90% cost-sharing back to the program's traditional 50% level. Since Wyoming never "expanded" Medicaid, this would have no impact on existing Wyoming Medicaid recipients.
Not reforming Medicaid would have a severely negative impact as, when the government runs out of money, or continues to print so much money that medical inflation bankrupts and closes healthcare facilities, they will have no access to care at all. Even worse than the huge fiscal effects on our state and the country, this runaway program is disrupting the core values that built this country, especially self-reliance.
In the operating room we have a dark truism that "all bleeding stops eventually". This means that either you get control of the bleeding, or the patient will simply bleed to death. Our federal government is bleeding, and we need to get control of it or, one way or another, it will stop.
Sincerely,
John Mansell, Gillette
